CommercialCoverageMedium impact
Rotavirus Vaccine (CPB 0723, reviewed 2025-11-25)
Aetna·Pediatrics, Family Medicine, General Practice +1 more·Medical Policy
Effective date
Nov 25, 2025
We identified it
Aug 16, 2026
Summary
Aetna's CPB 0723 (reviewed 2025-11-25) confirms medical necessity coverage for FDA-approved rotavirus vaccines (RotaTeq and Rotarix) in infants less than 8 months of age. This is a clinical policy bulletin reaffirming existing coverage with specific dosing schedules and age restrictions; billing teams must ensure claims are submitted only for eligible infants with appropriate CPT codes and encounter codes.
Action Required
Billing team must verify rotavirus vaccine claims meet the following criteria before submission: (1) Patient age is less than 8 months at time of vaccination; (2) CPT 90680 (RotaTeq, 3-dose series) is used ONLY when all 3 doses are administered between 6-32 weeks of age with first dose between 6-12 weeks; (3) CPT 90681 (Rotarix, 2-dose series) is used ONLY when both doses are administered between 6-24 weeks of age with first dose between 6-14 weeks and minimum 4-week interval between doses; (4) ICD-10 code Z23 is included on all claims for immunization encounters. Do NOT bill rotavirus vaccine for infants age 8 months or older or for any indications other than rotavirus gastroenteritis prevention. Update billing software validation rules and train front desk staff to verify patient age at check-in. Claims submitted for ineligible ages or off-label indications will be denied by Aetna.